Better urban planning is essential to improve health

30 May 2012

The
proportion of the world’s population that lives in cities has been steadily
rising, so that 3 in 5 of all people globally will live in a city by 2030. The
UCL-Lancet Commission
on Healthy Cities explores the many issues other than health services that
contribute to population health in a city environment.

The
Commission has been prepared by lead
author Professor Yvonne Rydin (UCL Bartlett School of Planning) and colleagues at
UCL and worldwide. The authors address issues that apply globally and use
specific examples from cities as diverse as London, Bogota, Accra, and Toronto
to illustrate the issues.

Just
as London’s first modern, large-scale, urban sewage treatment system resulted
in a 15-year increase in life expectancy between the 1880s and the 1920s, so
other large-scale planning initiatives can radically change the health outcomes
of city-dwellers – especially for the poorest. In this report the authors
recommend focusing on the delivery of a variety of urban projects that have a
positive impact on health.

While cities have the potential to be healthier places for their citizens, this requires active planning. Economic growth cannot be assumed to lift all urban citizens into a zone of better health.

Professor Yvonne Rydin

Examples
from the report include community-led sanitation infrastructure programmes in
the slums of Mumbai, India; action for urban greening to protect against heat
stress in London summers; and transportation initiatives that encourage
physical activity in Bogota, Colombia.

Professor
Rydin says: “While cities have the potential to be healthier places for their
citizens, this requires active planning. Economic growth cannot be assumed to
lift all urban citizens into a zone of better health. Even in scenarios where
health in a city has improved, without active maintenance of investments, gains
made can be reversed, leading to increased rates of death and disease.”

Today,
around 3.4 billion live in urban areas, projected to rise to 6.3 billion by
2050. This growth will likely lead to more megacities (population 10 million+)
concentrated in Asia, and more medium-sized cities in all locations, especially
Africa. Among the projected world population of 9 billion in 2030, some 2
billion could be living in slum-like conditions in cities worldwide.

There
is a perception that living in a city gives a person an ‘urban advantage’ over
their rural neighbours. Today, in high-income countries, health outcomes are
generally better in city than rural populations. But people living in poor
areas in wealthy cities can often have much worse health indicators than both
their wealthier city neighbours and some within the rural populations.

Professor
Rydin says: “In many urban areas, rich people and poor people live in different
epidemiological worlds, and the burden of ill-health is highest in the poorest
groups. The double burden of communicable and non-communicable diseases is
borne predominantly by poor people.”

The
Commission authors looked at cities as complex, interactive entities in which
changes in one part of the system can have impacts on others. They use five
case studies to illustrate important themes for healthy cities.

More information

Each
case study supports the argument for a new way of planning for urban health.
Planners need to recognise that conditions of complexity make it difficult to
capture all the necessary information about the links affecting urban health in
one plan or strategy. Unintended consequences of policy action are likely to
persist. Instead planners should be working with all urban health stakeholders,
including local communities, particularly vulnerable communities.

Professor
Rydin says: “There should be an emphasis on experimenting with and learning
from diverse urban health projects. This can mean supporting communities in
their own urban health projects, as with community latrines in Mumbai slums or
urban food projects in London and Detroit.”

The
Commission concludes with five
recommendations:

City
governments should build political alliances for urban health.

Governments
need to identify the health inequalities in cities.

Urban
planners should include health concerns in their plans, regulations and
decisions.

Experimentation
and learning through projects involving local communities is often the
best way forward.

Case study: urban agriculture

Urban agriculture presents opportunities
for economic, social and environmental benefits for cities. The solid organic
waste of city dwellers can be transformed via anaerobic digestion into gaseous
energy and digestate, which can be used for fertilization. Grey and black water
from showers, sinks, and gutters can be treated and used to irrigate crops.
Urban farms provide jobs and nutrition, reduce food miles and create pleasant
green spaces.

Case study: sanitation in India and Ghana

Dr Julio Davila, UCL
Development Planning Unit, talks about community-led approaches to sanitation
in informal settlements in Mumbai and Accra.